Rates In Italy Research Articles

Ostomy closure rate during COVID-19 pandemic: an Italian multicentre observational study.

During the corona virus disease 2019 (COVID-19) pandemic, most of the surgical procedures were performed for emergencies or oncologic reasons to the detriment of the remaining elective procedures for benign conditions. Ileostomy or colostomy creation are sequelae of oncologic or emergency colorectal surgery, but their closure does not fall within the definition of oncologic or emergency surgery. The aim of this retrospective multicentre observational study is to report the impact of COVID-19 pandemic on the ostomy closure rate in Italy. Data regarding ileostomy and colostomy creation and closure from 24 Italian centres, during the study period (March 2020–February 2021) and during the control period (March 2019–February 2020) were collected. Three hospitals (12.5%) were COVID free. The number of colostomies and ileostomies created and closed in the same period was lower ( -18.8% and -30%, respectively) in the study period in comparison to the control period (p = 0.1915 and p = 0.0001, respectively), such as the ostomies closed in the analysed periods but created before (colostomy -36.2% and ileostomy -7.4%, p = 0.2211 and p = 0.1319, respectively). Overall, a 19.5% reduction in ostomies closed occurred in the study period. Based on the present study, a reduction in ostomy closure rate occurred in Italy between March 2020 and February 2021. During the pandemic, the need to change the clinical practice probably prolonged deterioration of quality of life in patients with ostomies, increasing number of stomas that will never be closed, and related management costs, even if these issues have not been investigated in this study.

A new versatile modification of the Rayleigh distribution for modeling COVID-19 mortality rates

The aim of this paper is to specify a new flexible statistical model to analyze COVID-19 mortality rates in Italy and Canada. A new versatile lifetime distribution with four parameters is proposed by using the exponentiated generalized class of distributions and the gull alpha power Rayleigh distribution to form the exponentiated generalized gull alpha power Rayleigh (EGGAPR) distribution. This new distribution is characterized by a tractable cumulative distribution function. To estimate the unknown parameters of the proposed distribution the maximum likelihood estimation method is used. In evaluating the effectiveness of the MLE method graphical displays of the Monte Carlo simulation are presented. The EGGAPR distribution is compared to its sub-models which include the exponentiated gull alpha Rayleigh distribution, the gull alpha Rayleigh distribution, exponentiated generalized Rayleigh distribution, exponentiated Rayleigh distribution and the Rayleigh distribution. Different measures of goodness-of-fit are used to investigate whether the EGGAPR distribution is more flexible and fit than its sub-models in modeling COVID-19 mortality rates.

A D-vine copula-based quantile regression model with spatial dependence for COVID-19 infection rate in Italy

The main determinants of COVID-19 spread in Italy are investigated, in this work, by means of a D-vine copula based quantile regression. The outcome is the COVID-19 cumulative infection rate registered on October 30th 2020, with reference to the 107 Italian provinces, and it is regressed on some covariates of interest accounting for medical, environmental and demographic factors. To deal with the issue of spatial autocorrelation, the D-vine copula based quantile regression also embeds a spatial autoregressive component that controls for the extent of spatial dependence. The use of vine copula enhances model flexibility accounting for non-linear relationships and tail dependencies. Moreover, the model selection procedure leads to parsimonious models providing a rank of covariates based on their explanatory power with respect to the outcome.

Modelling the persistence of Covid-19 positivity rate in Italy

The current Covid-19 pandemic is severely affecting public health and global economies. In this context, accurately predicting its evolution is essential for planning and providing resources effectively. This paper aims at capturing the dynamics of the positivity rate (PPR) of the novel coronavirus using the Heterogeneous Autoregressive (HAR) model. The use of this model is motivated by two main empirical features arising from the analysis of PPR time series: the changing long-run level and the persistent autocorrelation structure. Compared to the most frequently used Autoregressive Integrated Moving Average (ARIMA) models, the HAR is able to reproduce the strong persistence of the data by using components aggregated at different interval sizes, remaining parsimonious and easy to estimate. The relative merits of the proposed approach are assessed by performing a forecasting study on the Italian dataset. As a robustness check, the analysis of the positivity rate is also conducted by considering the case of the United States. The ability of the HAR-type models to predict the PPR at different horizons is evaluated through several loss functions, comparing the results with those generated by ARIMA models. The Model Confidence Set is used to test the significance of differences in the predictive performances of the models under analysis. Our findings suggest that HAR-type models significantly outperform ARIMA specifications in terms of forecasting accuracy. We also find that the PPR could represent an important metric for monitoring the evolution of hospitalizations, as the peak of patients in intensive care units occurs within 12–16 days after the peak in the positivity rate. This can help governments in planning socio-economic and health policies in advance.

Cholangiocarcinoma and pleural mesothelioma: asbestos exposure as a shared risk factor? A comparison of age-standardized incidence rates in Italy

Cholangiocarcinoma and pleural mesothelioma: asbestos exposure as a shared risk factor? A comparison of age-standardized incidence rates in Italy

Educational Interventions on Pregnancy Vaccinations during Childbirth Classes Improves Vaccine Coverages among Pregnant Women in Palermo's Province.

Maternal immunization is considered the best intervention in order to prevent influenza infection of pregnant women and influenza and pertussis infection of newborns. Despite the existing recommendations, vaccination coverage rates in Italy remain very low. Starting from August 2018, maternal immunization against influenza and diphtheria-tetanus-pertussis were strongly recommended by the Italian Ministry of Health. We conducted a cross sectional study to estimate the effectiveness of an educational intervention, conducted during childbirth classes in three general hospitals in the Palermo metropolitan area, Italy, on vaccination adherence during pregnancy. To this end, a questionnaire on knowledge, attitudes, and immunization practices was structured and self-administered to a sample of pregnant women attending childbirth classes. Then, an educational intervention on maternal immunization, followed by a counseling, was conducted by a Public Health medical doctor. After 30 days following the interventions, the adherence to the recommended vaccinations (influenza and pertussis) was evaluated. At the end of the study 326 women were enrolled and 201 responded to the follow-up survey. After the intervention, among the responding pregnant women 47.8% received influenza vaccination (+44.8%), 57.7% diphtheria-tetanus-pertussis vaccination (+50.7%) and 64.2% both the recommended vaccinations (+54.8%). A significant association was found between pregnant women that received at least one vaccination during pregnancy and higher educational level (graduation degree/master’s degree), employment status (employed part/full-time) and influenza vaccination adherence during past seasons (at least one during last five years). The implementation of vaccination educational interventions, including counseling by healthcare professionals (HCPs), on maternal immunization during childbirth courses improved considerably the vaccination adherence during pregnancy.

Public opinion on vaccines: the role of the scientific community in Italy

Abstract Background After rising for years, vaccination rates in Italy fell until 2015 because of unfounded safety concerns, abetted by some government and court actions. Public education and a 2017 law on mandatory vaccination have boosted rates since then. So far only a few papers have examined the correlation between beliefs and attitudes towards vaccines and the level of trust in the scientific community regarding vaccinations in the general population. Methods Data were extracted from the Italian section of the last two editions of the European Social Survey (ESS), the first carried out between September and November 2017, the latter between December 2018 and March 2019. A descriptive analysis was conducted using survey data. In the two editions respectively 2,626 and 2,745 persons were interviewed. The main outcomes assessed was comparing the two surveys, so as to highlight the key changes in public opinion on vaccines. Results In the 2017 edition, 19% of the respondents believed in the harmfulness of vaccines, out of them 29% did not even have trust in the scientific community while those confident in the safety of vaccines were 50%. In the 2019 survey, the proportion of those who believed vaccines to be harmful fell to 15%, the undecided rose to 15%, those opposed to the idea that vaccines are harmful became 63%, not responding people were 8%. Correspondingly, trust in the scientific community about vaccines has increased from 57% in the first survey to 70% in the last one. Conclusions The scientific community and research bodies in the last years, in support of the Ministry of Health, have made a huge effort in the public debate on vaccines. This might play a role in increasing the public confidence in the safety of vaccines and the adherence to vaccination campaigns, changing the climate with regard to vaccination in general. Key messages Italians changed their opinions on vaccines between two ESS surveys. The scientific community had a relevant role in the public debate on vaccines.

Vaccine Hesitancy and Trust in the Scientific Community in Italy: Comparative Analysis from Two Recent Surveys.

Vaccination rates in Italy fell until 2015 because of unfounded safety concerns. Public education and a 2017 law on mandatory vaccination have boosted rates since then. The aim of our study is to explore how trust in the scientific community and attitudes towards vaccines have changed in the period of 2017–2019 in Italy. Data were extracted from the Italian section of the 2017 and 2019 editions of the European Social Survey (ESS). We compared the two surveys highlighting changes in public opinion on vaccines. A descriptive analysis of the socio-cultural variables according to the answers provided to key questions on the harmfulness of vaccines was conducted. Differences between percentages were tested by using the χ2 test. The association between the opinion about the harmfulness of vaccines and trust in the scientific community was analyzed through a logistic regression model. Compared to ESS8, ESS9 showed an increase in the percentage of respondents disagreeing with the harmfulness of vaccines. Trust in the scientific community raised in the period from 2017 to 2019 (59% vs. 69.6%). Higher education was significantly associated with disagreement regarding the harmfulness of vaccines (odds ratio (OR) = 2.41; 95% confidence interval (95%CI) 1.75–3.31), the strongest predictor was trust in the scientific community (OR = 10.47; 95% CI 7.55–14.52). In Italy, trust in the scientific community and in vaccinations has grown significantly in recent years, indicating a paradigm shift in public opinion compared to the past. Central actions and effective public communication strategies might reduce vaccine hesitancy and could be essential to garner public trust.

Understanding the Factors Affecting COVID-19 Mortality in Italy: Does a Relationship Exist With a Sharp Increase in Intensive Care Unit Admissions?

The present study aims to explore whether a relationship exists between the immediate sharp increase in intensive care unit (ICU) admissions and the mortality rates in Italy. Official epidemiological data on coronavirus disease (COVID-19) were employed. The forward lagged (0, 3, 7, 14 days) daily variations in the number of deaths according to the number of days after the outbreak started and the daily increases in ICU admissions were estimated. A direct relationship between the sharp increase of ICU admissions and mortality rates has been shown. Furthermore, the analysis of the forward lagged daily variations in the number of deaths showed that an increase in the daily number of ICU admissions resulted in significantly higher mortality after 3, 7, and 14 days. The most pronounced effect was detected after 7 days, with 250 deaths (95% CI: 108.1-392.8) for the highest increase in the ICU admissions, from 100 to 200. These results would serve as a warning for the scientific community and the health care decision-makers to prevent a quick and out-of-control saturation of the ICU beds in case of a relapse of the COVID-19 outbreak.

Hand and Upper Limb Malformations in Italy: A Multicentric Study.

Background: Although hand and upper limb malformations are quite frequent, up to now very few reports have been published on epidemiology. The aim of this study is to evaluate the number of infants who presented with hand and upper limb malformations from 2010 to 2015 in Italy. Methods: A retrospective analysis of a pediatric population presenting with hand and upper extremity malformations was carried out, gathering reports achieved from eight Italian Centers of pediatric hand surgery. Other factors such as gender, date and region of birth, family distribution of malformations and associated syndromes, were analysed. Results: Out of 3,100,421 live births, 765 children presented with hand and upper limb malformations. The incidence was 2,5/10,000 live births with a predominance of males and the right side. Radial polydactyly was the anomaly with the highest percentage, closely followed by simple syndactyly, simbrachidactyly and complex syndactyly. Less common conditions were the triphalangic thumb, thumb in palm, proximal radioulnar synostosis and Sprengel deformity. Inheritance of and familial predisposition to those malformations was recorded in 25 cases, while 84 children presented with syndromes related to hand anomalies. Conclusions: In conclusion the incidence of hand and upper extremity malformations in Italy is lower than that registered in other countries. The retrospective nature of the study combined with the fact that some defects frequently evade pediatric hand surgeon consultations are some possible limitations of the study. However, our data confirmed that, in spite of the decrease in the birth rate in Italy, the trend of congenital hand disorders maintained a stable trend. We aim to integrate this study with a prospective analysis and to involve the institutional health authorities in other countries so as to register the correct incidence of hand and upper extremity defects.

European trends in cervical cancer mortality in relation to national screening programs, 1985–2014

BackgroundCervical cancer is the fourth leading oncological cause of death in women. Variable trends in cervical cancer mortality have been observed across Europe, despite the widespread adoption of screening programs. This variability has previously been attributed to heterogeneity in the quality of screening programs. MethodsAge-standardized cervical cancer death rates for European countries between 1985 and 2014 were analyzed using Joinpoint regression. Countries were dichotomized based on year of implementation and population invitational coverage of national population-based cervical cancer screening programs. National cervical cancer mortality trends during the study period were compared based on this classification. ResultsDecreasing trends in mortality were observed in all European countries with the specific exceptions of Bulgaria, Greece and Latvia. The highest rates of cervical cancer mortality throughout the study period were in Romania (16.0-14.9/100,000) and the lowest rates in Italy (1.4-1.2/100,000). The greatest percentage decline in mortality was observed in the United Kingdom and the greatest absolute reduction in mortality was seen in Hungary. European countries which implemented a national population-based cervical cancer screening program prior to 2009 demonstrated greater improvements in cervical cancer mortality outcomes compared to those that did not (p = 0.016). ConclusionCervical cancer mortality is improving in most European countries; however, substantial variation remains. Trends in mortality were associated with the time of implementation of national population-based cervical screening programs.

Trends of major antimicrobial resistance phenotypes in enterobacterales and gram-negative non-fermenters from ATLAS and EARS-net surveillance systems: Italian vs. European and global data, 2008-2018

Antimicrobial resistance (AMR) is a growing health concern over the recent years. High AMR levels have been reported in Italy among European countries. Here, we analyze longitudinally the AMR trends observed in Italy for Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter cloacae and Pseudomonas aeruginosa from the Antimicrobial Testing Leadership and Surveillance database, in comparison with data from the European Antimicrobial Resistance Surveillance Network (2008-2018). We also compare these longitudinal data from Italy with those from Europe and globally. Data analysis revealed highest resistance rates for carbapenems and difficult-to-treat resistance in A. baumannii (82.4% and 83.6%, respectively) followed by third-generation cephalosporin-resistant K. pneumoniae in Italy (≥50%). Resistance rates in Italy were higher compared to Europe and globally, as observed in both Antimicrobial Testing Leadership and Surveillance and European Antimicrobial Resistance Surveillance Network. These findings further substantiate the high AMR rates in Italy and aim to support informed decision making at a national level.

A Quantitative Benefit-Risk Analysis of ChAdOx1 nCoV-19 Vaccine among People under 60 in Italy.

The Oxford-AstraZeneca ChAdOx1 nCoV-19 is a vaccine against the COVID-19 infection that was granted a conditional marketing authorization by the European Commission in January 2021. However, following a report from the Pharmacovigilance Risk Assessment Committee (PRAC) of European Medicines Agency, which reported an association with thrombo-embolic events (TEE), in particular disseminated intravascular coagulation (DIC) and cerebral venous sinus thrombosis (CVST), many European countries either limited it to individuals older than 55–60 years or suspended its use. We used publicly available data to carry out a quantitative benefit–risk analysis of the vaccine among people under 60 in Italy. Specifically, we used data from PRAC, Eudravigilance and ECDC to estimate the excess number of deaths for TEE, DIC and CVST expected in vaccine users, stratified by age groups. We then used data from the National Institute of Health to calculate age-specific COVID-19 mortality rates in Italy. Preventable deaths were calculated assuming a 72% vaccine efficacy over an eight-month period. Finally, the benefit–risk ratio of ChAdOx1 nCoV-19 vaccination was calculated as the ratio of preventable COVID-19 deaths to vaccine-related deaths, using Monte-Carlo simulations. We found that among subjects aged 20–29 years the benefit–risk (B-R) ratio was not clearly favorable (0.70; 95% Uncertainty Interval (UI): 0.27–2.11). However, in the other age groups the benefits of vaccination largely exceeded the risks (for age 30–49, B-R ratio: 22.9: 95%UI: 10.1–186.4). For age 50–59, B-R ratio: 1577.1: 95%UI: 1176.9–2121.5). Although many countries have limited the use of the ChAdOx1 nCoV-19 vaccine, the benefits of using this vaccine clearly outweigh the risks in people older than 30 years. Study limitations included risk of underreporting and that we did not provide age-specific estimates. The use of this vaccine should be a strategic and fundamental part of the immunization campaign considering its safety and efficacy in preventing COVID-19 and its complications.

In vitro activity of cefiderocol and comparators against isolates of Gram-negative pathogens from a range of infection sources: SIDERO-WT-2014–2018 studies in Italy

Antimicrobial resistance, particularly carbapenem resistance, in Gram-negative pathogens poses a significant healthcare threat. Carbapenem resistance rates in Italy are among the highest in Europe. We report the in vitro activity of cefiderocol, a novel siderophore cephalosporin, and comparator antibiotics against Gram-negative isolates from Italy as part of the SIDERO-WT studies. Isolates were collected between 2014 and 2018. Minimum inhibitory concentrations (MICs) were determined using International Organization for Standardization and EUCAST guidelines. Antimicrobial susceptibilities were interpreted using EUCAST breakpoints; pharmacodynamic/pharmacokinetic breakpoints were used if EUCAST breakpoints were not specified. The 2472 isolates [1545 (62.5%) Enterobacterales and 927 (37.5%) non-fermenters] represented a range of infection sources, including nosocomial pneumonia (902; 36.5%), complicated urinary tract infection (374; 15.1%), bloodstream infection (596; 24.1%), complicated intra-abdominal infection (257; 10.4%) and other infection sources (343; 13.9%). Cefiderocol was active against the majority of isolates, regardless of infection source (susceptibility, 94.2-97.3%). A high proportion of non-fermenters (97.6%) and Enterobacterales (95.6%) were cefiderocol-susceptible, although susceptibility was lower in Klebsiella pneumoniae (88.1%). Susceptibility to cefiderocol was significantly (P < 0.01) greater than comparators overall (96.4% vs. 71.3-81.6%) and in non-fermenters (97.6% vs. 44.3-90.3%) across infection sources. Overall 612/2472 isolates (24.8%) were meropenem-resistant (MIC > 8 mg/L), comprising 516/927 (55.7%) non-fermenters and 96/1545 (6.2%) Enterobacterales. Cefiderocol (499/516; 96.7%) activity was greater than colistin (440/516; 85.3%), ceftazidime/avibactam (123/516; 23.8%) and ceftolozane/tazobactam (89/516; 17.2%) in meropenem-resistant non-fermenter isolates. Susceptibility to cefiderocol was significantly greater than meropenem, colistin, ceftazidime/avibactam and ceftolozane/tazobactam overall, regardless of infection source.

Impact of Antidepressant Prescriptions on Suicidal Behavior in Times of Severe Financial Strain.

This descriptive study observes the relationship between antidepressant prescriptions and the suicide rate in Italy in the 2000s to the mid-2010s, which includes a period of severe economic crisis. The observation period was from 2000 to 2015. Suicide and unemployment rates disaggregated by age and sex were collected from the Italian Institute of Statistics. Statistical analyses were performed using correlations between suicide rates and the defined daily dose, with reference to selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other types of antidepressants. Fixed-effects panel regressions were also run. Increases in SSRIs prescriptions were associated with decreases in suicide rates among both men and women. However, when the analyses were adjusted for the rate of growth of the unemployment rate and for gross domestic product, the associations were weaker. The potential protective factor of SSRIs with respect to suicidal behavior may be reduced by severe recessions, especially when unemployment increases.

A Statistical Analysis of Death Rates in Italy for the Years 2015–2020 and a Comparison with the Casualties Reported from the COVID-19 Pandemic

We analyze the data about casualties in Italy in the period 1 January 2015 to 30 September 2020 released by the Italian National Institute of Statistics (ISTAT). The aim of this article was the description of a statistically robust methodology to extract quantitative values for the seasonal excesses of deaths featured by the data, accompanying them with correct estimates of the relative uncertainties. We will describe the advantages of the method adopted with respect to others listed in literature. The data exhibit a clear sinusoidal behavior, whose fit allows for a robust subtraction of the baseline trend of casualties in Italy, with a surplus of mortality in correspondence to the flu epidemics in winter and to the hottest periods in summer. The overall quality of the fit to the data turns out to be very good, an indication of the validity of the chosen model. We discuss the trend of casualties in Italy by different classes of ages and for the different genders. We finally compare the data-subtracted casualties, as reported by ISTAT, with those reported by the Italian Department for Civil Protection (DPC) relative to the deaths directly attributed to the Coronavirus Disease 2019 caused by the SARS-CoV-2 virus (COVID-19), and we point out the differences in the two samples, collected under different assumptions.

A new extended rayleigh distribution with applications of COVID-19 data

This paper aims to model the COVID-19 mortality rates in Italy, Mexico, and the Netherlands, by specifying an optimal statistical model to analyze the mortality rate of COVID-19. A new lifetime distribution with three-parameter is introduced by a combination of Rayleigh distribution and extended odd Weibull family to produce the extended odd Weibull Rayleigh (EOWR) distribution. This new distribution has many excellent properties as simple linear representation, hazard rate function, and moment generating function. Maximum likelihood, maximum product spacing and Bayesian estimation methods are applied to estimate the unknown parameters of EOWR distribution. MCMC method is used for the Bayesian estimation. A numerical result of the Monte Carlo simulation is obtained to assess the use of estimation methods. Also, data analysis for the real data of mortality rate is considered.

Azole resistance in Aspergillus isolates by different types of patients and correlation with environment - An Italian prospective multicentre study (ARiA study).

A wide range of frequency of azole-resistance in A fumigatus in different patient populations worldwide was observed threatening to reduce therapeutic options. Estimate the prevalence of azole-resistance, investigate the molecular mechanisms of resistance, compare the genotypes of resistant clinical isolates with those from the surrounding environment. Aspergillus isolates were collected by seven Italian hospital microbiology laboratories. Strains were isolated from different clinical samples from unselected patients. The azole-resistance was evaluated using screening test and microdilution EUCAST method. The molecular mechanism of resistance was performed sequencing the cyp51A gene. Resistant isolates were genotyped by microsatellite analysis and their profiles compared with those of azole-resistant isolates from previous Italian studies. 425 Aspergillus isolates from 367 patients were analysed. The azole-resistance rates were 4.9% and 6.6% considering all Aspergillus spp. isolates and the A fumigatus sensu stricto, respectively. All resistant isolates except one were from a single hospital. Two rare azole-resistant species were identified: A thermomutatus and A lentulus. The predominant resistance mechanism was TR34 /L98H. No correlation between the clinical resistant strains and environmental isolates from patients' home/work/ward was observed. The analysis of the molecular correlation between the resistant clinical strains collected in the present study and those of environmental and clinical origin collected in previous Italian studies reveals a progressive diversification of azole-resistant genotypes starting from a founder azole-resistant genotype. This study confirms the trend of azole-resistance rate in Italy, showing a geographical difference. Data reinforce the importance of surveillance programmes to monitor the local epidemiological situation.

The Effects of Air Pollution, Sea Exposure and Altitude on COVID-19 Hospitalization Rates in Italy.

Early known cases of COVID-19 emerged in late 2019 in the city of Wuhan (China) and in a relatively short time, it has reached more than 200 countries up to July 2020. In Italy, from 21 February 2020, (first official Italian positive case of COVID-19) until 27 July 2020, 246,286 confirmed cases were observed of which over 68,150 (28%) needed hospitalization and 35,112 died. In recent scientific research, it has been shown that the severity of symptoms and mortality rates were different not only among the various countries of the world but also in different regions of the same country. This research investigates whether and by how much air environmental conditions (such as exposure to fine particulate matter-PM2.5, sea air masses and altitude) influences the risk of hospitalization due to COVID-19 in Italy, once the spreading of the virus and the percentage of the elderly in the population have been accounted for. A log-linear multiple regression model was estimated where the log of the ratio of hospitalized patients per inhabitant, since the beginning of the epidemic up to July 27, has been considered as a dependent variable. Among the independent variables, the ones that have been taken into account are the spreading of the virus, the rate of people over 50 years of age, the concentration of PM2.5, the rate of population living by the sea, the rate of green public space for each resident and the ratio of population living at a high altitude. The results showed an increase in the hospitalization rate in terms of the percentage of people over 50 and the average concentration of PM2.5. If average limits of PM2.5 concentration allowed by the current European regulations (25 µg/m3) were respected in all Italian provinces, that would have led to 7339 less hospitalizations for COVID-19 (−11%). On the contrary, near the coast there were lower hospitalized cases in the referred period. In the hypothetical case that no Italians lived near the sea, about 1363 (+2%) more hospitalizations would have been recorded in the analysis period in addition to the effect of a lower PM concentration. This paper wanted to investigate which are the areas with a higher risk of hospitalization in Italy, so as to help the Italian Government to strengthen Health System measures, predicting the most suffering areas and health care systems. According to the results, this is directly related to the severity of symptoms which decreased with the long-time exposure to the sea.

An assessment of case-fatality and infection-fatality rates of first and second COVID-19 waves in Italy.

Background and aim:The exact COVID-19 severity is still not well defined and it is hotly debated due to a few methodological issues such as the uncertainties about the spread of the SARS-CoV-2 infection.Methods:We investigated COVID-19 case-fatality rate and infection-fatality rate in 2020 in Italy, a country severely affected by the pandemic, basing our assessment on publicly available data, and calculating such measures during the first and second waves.Results:We found that province-specific crude case-fatality rate in the first wave (February-July 2020) had a median value of 12.0%. Data about infection-fatality rate was more difficult to compute, due to large underestimation of SARS-CoV-2 infection during the first wave when asymptomatic individuals were very rarely tested. However, when using reference population-based seroprevalence data for anti-SARS-CoV-2 antibodies collected in May-July 2020, we computed an infection-fatality rate of 2.2%. During the second wave (Sep-Dec 2020), when SARS-CoV-2 testing was greatly increased and extended to many asymptomatic individuals, we could only compute a ‘hybrid’ case/infection-fatality rate with a value of 2.2%, similar to the infection-fatality rate of the first wave.Conclusions:Overall, this study allowed to assess the COVID-19 case- and infection-fatality rates in Italy before of variant spread and vaccine availability, confirming their high values compared with other airborne infections like influenza. Our findings for Italy were similar to those characterizing other Western European countries.